Karen Ansell, Medicare Insurance Agent

Answer: As long as your Employer coverage is considered credible coverage you will have the option to stay with them and apply for Medicare. If you decide to stay with your Employer coverage you will have a special enrollment period to enroll in Medicare at a later date.

You can contact your HR department to verify it is credible. Then compare the benefits and premiums to those of the cost of Medicare and a Supplement and Part D rx or an Advantage plan with rx coverage. to your Employer plan.

You can apply for Medicare A only which is a $0 premium as long as you have worked 40 quarters into the Social Security system. However, if you do this you can no longer contribute to your HSA account.

Answer: Most Medicare plans whether Medicare Supplement or Advantage plans do not cover long term care at home. However they can pay short term skilled care for her which is more rehab.

There are programs through Medicaid that can help with care if she qualifies financially. Every state has different rules for qualifying for long term care. Contact your local Medicaid office for assistance.

If your parent does not qualify for Medicaid, I would advise your to contact a local Elder Care Attorney for assistance.

Answer: Medicare itself will not pay outside of the United States.

However Medicare Supplements C, D, F, G, M, and N provide the most coverage for foreign travel emergencies, paying 80% of billed charges after a $250 deductible, with a lifetime limit of $50,000.

Some Medicare Advantage plans also offer international emergency coverage, which varies by plan

Answer: Medicare recipients have certain times of the year they can change their Medicare Advantage plan. Annual Enrollment is from October 15th through December 7th with an effective date of January 1st. Then Open Enrollment is only for Medicare Advantage plan holders. They can change their plan one time January 1st through March 31st with the first of the following month the effective date after the application date. Their can be Special Enrollment times throughout the year such as weather related or you move out of the service area of your plan when you can change.

Medicare Supplement holders have a 6 month window starting the first month you enroll in Medicare part B that you can changes plans with no health questions asked. After this time you can change all year long. However, the new plan will normally have a medical application you must pass to change to the new plan.

Answer: The medical loss ratio compares how much of a premium goes toward paying medical claims compared to the amount that an insurer pays for administrative costs. Medicare Advantage plans are required to spend at least 85% in medical claims. Which can mean better care.

However there are other things that effect the quality of care you receive. A large network of providers, the ease of receiving authorizations and good customer service.

Answer: No, not everyone over the age of 65 qualify for Medicare. You must be a legal US Citizen and over the age of 65. Medicare Part A will be $0 cost as long as you worked 40 quarters into the Social Security system. Medicare Part B in 2026 is $202.90 per month unless your income is above a certain amount. If it is you will pay more.

You can have Medicare under age 65 if you qualify for disability for 2 years.

Answer: Medicare Part B is a part of Medicare which has a premium of $205 per month unless your income is over a certain amount then you will pay more for Part B.

It is your medical benefits such as your primary care doctors, specialists, surgeons and any doctor you receive treatment from this can be in a hospital or outpatient. Medical equipment such as wheel chairs, walkers and hospital beds.

It also consists of certain Part B injectable and cancer drugs.

You are normally responsible for a 20% copays and an additional 15% if your doctor does not take Medicare assignment.

Answer: Medicare still has large deductibles for inpatient stays and you owe 20% on all doctors that serviced you while you were in the hospital. Or they may be experiencing kemo or radiation which again is a 20% coinsurance which can be an ongoing treatment. Also Medicare does not have a cap or out of pocket maximum.

Answer: You may be able to switch to a Medicare Advantage plan if you qualify for a special enrollment period. There are several you might qualify: if you are in the First twelve months being in the Medicare Supplement or you may be in a county that has experienced a disaster special enrollment. Call your local broker.

Answer: It is not mandatory that you sign up for a hospital indemnity plan that pay for hospital stays.

It is an option. However I like them. they are inexpensive and can pay some of the highest copays that you have with a Medicare Advantage plan. Depending on the plan they can pay for the hospital copays, emergency room, rehab, and a benefit for cancer normally a flat benefit amount.

Answer: You can sign up for Medicare Part A only and stay on your spouses Work insurance as long as he is working and the coverage is credible coverage. Credible coverage is defined coverage as good as Medicare coverage. You do not need to notify Medicare at this time. When you are ready to go onto Medicare Part B there is a form that you will fill out "form cms-408 and there is a form that his employer will fill out "cms-L564" verifying you have coverage since you were eligible for Medicare. You should start this process 3 months before the date you want Medicare B effective.

Answer: I have been working with Medicare recipients for over 37 years the stories hands down are the best. Stories of the Wars, the African American movement, decades of stories.

truly the best thing about my job are the clients.

Answer: I believe the biggest disadvantage is the approvals for procedures that are not required from original Medicare. Such as joint replacements: Your MRI and other testing will require approval and they normally require so many days of therapy before they will approve the procedure.

Answer: No Medicare will not cover medical marijuana because Medicare is a federal program and marijuana is not FDA approved regardless of state legality.

Answer: If your Dad's income changes and he qualifies for Medicaid he can change his current plan to a plan that works best with his level of Medicaid. This can drop his out of pocket expenses or even eliminate them depending on his income and assets.

Answer: I start with the basics. I explain how Medicare Parts A & B work and then show them their Medicare Supplement options. I get a list of their medications and show them the best Part D prescription plan for them.

Next I explain their is a second option that replaces their Medicare benefits with Insurance companies plans which are called Medicare Advantage plans. The plan I would show them would depend on their doctors, medications, hospital and pharmacy choices. I normally show them an HMO and a PPO plan explaining the HMO requires referrals to see specialists.

These plans also may require prior authorization for certain services.

Answer: If you are incurring more bills than you thought you would you may want to increase your coverage with a higher premium. You can figure this out by looking at your out of pocket expense compared to the difference in premium.

Answer: Each Medicare Advantage plan has a network of doctors and hospitals that you will need to adhere to. Check with the plan to see if your providers are in network.

Also, it is important to know that a doctor can opt out of the plan during the year as well/

Answer: You can look the agent up in the state in which they are licensed to see how long they have been in the industry and any complaints they have had. Ask for references.

The agent should also have a process in which they evaluate your situation to make sure they get you the best plan for your individual needs. They should ask for a list of your doctors, medications, hospital and pharmacy of choice.

Answer: You can call 1800Medicare or go online and create an account at www.Medicare.gov to order a new Medicare card.

Answer: You can be penalized if you do not take Medicare at age 65 up to 10% a year and if you do not take a prescription plan 1% per month.

However, in certain situations you do not have to take Medicare and will not incur a penalty.

If you or your spouse are currently working and have credible coverage through their employer you do not have to take Medicare.

Answer: In 2026 there is not a donut hole.

There are three stages.

1. the deductible, this can be $0 or maximum of $615.00

2. After the deductible You will pay $ copays or a % of the cost of your medications up to a max of $2100.00 out of pocket for the year.

3. After the $2100 you will pay $0

You want to make sure that the prescription plan you choose covers both your medications and your pharmacy of choice. You can call 1-800Medicare for a comparison.

Answer: I have been selling Medicare insurance for 37 years and I just turned 65 in February and my mail box is full everyday. I would advise to speak with a local broker who represents many companies. They should ask for a list of your doctors, hospitals, medications and preferred pharmacy to do the research for you.

Your first choice is going to be Medicare Supplement or Medicare Advantage plan. The broker can explain the differences for you.

Answer: If they factored in the premiums plus the copays for the total cost and the plan they have is higher than other plans I can only guess either they just did not want to change because they had been with their plan for so long or they do not understand the plans.

Answer: You can apply for several programs.

Low Income Subsidy which is a program that helps pay your prescription plan premiums and your copays for your medications. You can apply on www.Medicare.gov or www.ssa.gov/extrahelp. The program does have income and asset levels.

You can also apply for assistance through the medication's pharmaceutical company.

Not all companies have assistance but many do. Your income and assets can be much higher than government programs. You can apply at www.assist.org or ther are other sites.

Also many of my clients use www.goodrx.com or a similar program to help lower the cost. You can also ask your current prescription plan for a lower tier adjustment.

Answer: When you have been on disability for 24 months you will automatically be enrolled into Medicare part A & B. You will receive your Medicare card near that 24 month time. You should then seek advise from a licensed broker for part D options and or Medicare supplements or Advantage plans.

Answer: Medicare does not normally pay for care outside the United States except for limited care in Canada and on a Cruise ship. If you have a Medicare Supplement or "Gap Plan" they will pay 80% up to $50,000.00 lifetime with a $250.00 deductible.

Answer: Some Medicare Advantage plans offer dental and vision. Make sure your doctors, hospital, medications and dentist is in network with the plan.

If you have a Medicare Supplement or straight Medicare you will have to purchase a separate plan.

Answer: ESRD and starting dialysis makes you eligible for Medicare, regardless of age, but the coverage start date depends on your treatment. For in-center hemodialysis, coverage typically begins on the first day of the fourth month of treatment. However, you may get coverage sooner if you start training for home dialysis before the fourth month begins.

The coverage from Medicare will be the same. They will pay 80% of the approved amount for in center and at home. Normally you are responsible for the 20% as long as the facility or Home Care excepts Medicare. You may also be responsible for deductibles, copays, and other out-of-pocket costs.

Answer: The financial risk can be great. With no maximum out of pocket.

Part A hospital

Days 1-60 $1676.00 deductible, payable every benefit period.

Days 61-90 $419.00 per day charge

Days 91-150 $838 per day

After day 150 you pay 100%

Skilled Nursing care 1-20th day $0 copay

21 - 100 days $279 per day

Part B "doctors services in or out of hospital, testing, medical equipment, etc."

You pay $257 deductible, 20% of approved and excess charges if non-assignment charge

Answer: Yes an "ANOC" or annual notice of change is required for Medicare Advantage and prescription plans. You should receive this by October 1st. It is very important you read this document and keep it throughout the year.

Answer: Medicare brokers can represent many different companies while a Medicare agent may only represent one company.

Answer: Talk with a professional, preferably someone local to you who is a broker. Brokers can represent many companies, so they are looking out for your best interest not the insurance company. Make sure this person requests a list of your doctors, medications, hospital and pharmacy of choice.

Answer: I encourage all my Medicare Advantage plan clients to add a hospital indemnity with a cancer rider. They are very inexpensive.

Answer: Medicare Supplements are sometimes called secondary insurance or medi-gap insurance.

Medicare A & B primary with "secondary insurance" or Medicare Supplement.

Answer: Annuities are very important for retirement planning.

In my situation have enough income and in a high tax bracket.

Annuities are currently paying approximately 5% compounded and tax differed on a 5 year investment. Which will lower my tax bracket.

You will pay taxes when you take out the money on the interest earned if it is non qualified or 100% taxed if qualified such as an IRA or 401K.

Important to understand Annuities are considered a long term investment approx 5-7 years or longer.

Answer: It is very important to compare plans yearly. Speak with a broker who represents many plans. Have them compare your doctors, medications, hospital and pharmacy of choice to all plans to make sure you are getting the best plan for your individual needs.

I would recommend to read your Annual Notice of Change closely. Annual Enrollment starts October 1st with applications excepted between October 15th - December 7th with an effective date of January 1st.

Answer: I have been working with Medicare beneficiaries for over 35 years and have found that my clients are unhappy with their plans for several reasons.

Clients have a network of providers to adhere to. Doctors and hospitals can opt in or out of the plan during the year. Most plans require prior authorization for testing and some medications.

Plan benefits change every year, some copays and out of pocket maximum's can be high.

Answer: Over the past 37 years of my career I have seen Medicare approving more treatments. CAR T-cell gene therapy for cancer is currently approved as long as it meets FDA and CMS criteria and the Cell and Gene Therapy Model. I believe more gene therapy will be approved as long as the results of the therapy are positive.

Answer: Yes, Once you are disability for 24 months you will automatically qualify for Medicare coverage. No matter the reason for your disability.

Answer: If your Medicare Advantage plan denies coverage you should start the appeals process. This should be done with in 60 days of the denial. Get your primary care doctor to help you with the process. You will want to send supporting documents in with the appeal as well.

You can contact your states SHIP program or the Medicare ombudsman for assistance.

Answer: I can understand why you think you are getting conflicting advise. there are multiple factors why to draw early or wait. And they all depend on you.

1. are you continuing to work. if so this can effect the amount you will draw or may put you in a higher tax bracket.

2. Look at your overall financial situation.

3. If married can effect your spouses benefits when you pass away.

4. if you are in poor health or may have a shorter than average life expectancy it may be better to draw early.

and more...

Taking Social Security at 62 instead of waiting to full retirement for example 67 can reduce your monthly benefit by 30%.

Break-Even Age:

The break-even age is when the cumulative benefits received from claiming at full retirement age (or later) surpass the cumulative benefits received from claiming at 62. For most people, this is around age 78 or later.

I advise to speak to a financial advisor can help you assess your specific situation and make an informed decision.

Answer: That is a good question.

Your spouses employer is the one who determines whether you will continue to have employer coverage. I would contact the HR department or call the number on the back of your card and they can give you a number to call to find this out.

If your employer coverage does not continue do not worry. You have a special enrollment period under Medicare of up to 8 months to apply for parts A & B. You will need to fill out forms CMS-40B and the employer fills out form CMS-L564 and either hand deliver or fax or upload into the Social Security office.

If you already have A & B and are just needing a Medicare supplement or other Medicare plan you have 63 days of when your group plan ended to apply for them with no health questions asked. You will also need a prescription plan.

Answer: No you did not make a mistake. Medigap plans are good anywhere in the United States as long as the provider accepts Medicare and the charge is approved by Medicare.

Some of the Medicare Advantage plans have nationwide coverage. This does not mean it covers all Medicare providers. Also in an emergency situation the plan will pay any Medicare approved provider.

Example. I live in Jacksonville, FL. Mayo in Jacksonville does not accept any Medicare Advantage plan except in an emergency situation.

Answer: Those Medicare recipients who have brand name drugs will benefit the most.

All approved medications are capped at $2000 annually.

This means any deductible and copays you pay will go towards the $2000.

And if your copays are less than 25% of the Medicare total cost of the drug then the 25% will go towards the $2000 making your cost even lower.

Answer: After an annual deductible of $257.00 the plan G should cover all costs as long as Medicare approves the charges.

Answer: You can go to the insurance plans website and check to see if her doctors are in network.

I would always advise to work with a broker who can check all the plans in her area. This will save you time and you will have a professional to assist you in finding the best benefits and large network of providers.

Answer: If you missed your 7 month window to sign up for Medicare A& B you can sign up during your general enrollment available January 1st through March 31. You may also qualify for another guaranteed issue which will give you another option to sign up.

Answer: Yes, 2025 Part D changes will help those on expensive medications.

The out of pocket maximum for Medicare Part D plans is $2000.00. As long as the medication in approved by your insurance company. You can check on www.Medicare.gov what your out of pocket costs will be monthly and approximately when you will hit the $2000 out of pocket maximum.

Answer: Information on the new Part D plans will be available October 1st.

I have found the best place to compare is www.Medicare.gov.

Answer: The out of pocket costs for part D for a Medicare recipient is capped at $2000.00 for 2025.

This includes the deductible and copays as long as the medications is approved by the part D insurance plan.

Answer: Medicare supplements or Medigap plans are standardized in most states. These plans are A-N and the plans themselves are different depending on the letter plan you choose. Once you choose a letter plan that plan has identical benefits no matter which insurance company you choose. Insurance companies differ on premium and customer service. Some Insurance companies offer added benefits such as gym membership, and discounts on vision and hearing.

There are three states that have their own unique plans: Massachusetts, Minnesota and Wisconsin. In these states you will find different options than the lettered plans.

This can be a confusing process, I advise to work with a broker who represents many companies so they can advise you on the bet plan for your individual needs.

Answer: Over the years Medicare has spent millions of dollars on fraud , waste and abuse from people intentionally deceiving Medicare resources for their own personal gain.

You can take steps to help protect Medicare for the future.

1. Check your Summary of Benefits you receive from Medicare to make sure the charges are correct and that you actually received them.

2. Make sure you have a secure account with Medicare and do not give out your Medicare number to anyone you do not know.

3. Report to 1-800Medicare any charges or supplies you receive that are not correct.

Answer: You have several options to help with medication costs.

1. Look into Low Income Subsidy which is through your state. This benefit can assist you with your Part D premium and costs of your medications. You can apply through www.Medicare.gov or www.ssa.gov. You must meet certain income and resource limits.

2. I also recommend contacting the pharmaceutical company who makes the medication.

They may have programs available to help with the medication costs and are easier to qualify for.

3. Consider an alternative medication with lower copays.

4. The 2025 Part D prescription plans have a maximum of $2000.00 annually out of pocket for all your medications together.

Answer: Yes, a Medicare part D plan can deny coverage for a brand if a generic is not available.

All plans have formularies which is a list of medications that they cover. Even though that specific medications might not be covered they must have meds that are covered for all illnesses.

Answer: Yes they can be very helpful but you are right depending on the group giving it can sound like a big sales pitch. I would attend several meetings and then work with a local agent who can help you choose the best plan for your individual needs.

Answer: Medicare Part D pays the costs of medications with a deductible and copays up to a maximum of $2000.00 out of pocket for covered drugs. Without Part D seniors could incur much more out of pocket with no maximum out of pocket.

Answer: Mental Health for us seniors is very important. I just turned 65 and have been having virtual calls with a psychologist once a week which is covered by Medicare and my Medicare Advantage plan.

Answer: I think many seniors assume they will automatically be enrolled into Medicare when they turn 65. I recently turned 65 and the info I got from Social Security was late and hard to understand. And of course we know trying to call Social Security is very difficult.

I think Medicare info needs to be gotten to Medicare recipients 6 months before their bday.

Keep the info short - If not drawing a monthly Social Security benefit check you need to physically sign up for Medicare yourself 3 months before your birth month.

Seminars are a great way to draw business.

Answer: I believe these commercials are misleading and should be banned. These celebrities will not be your agent and are not a licensed agent.

Answer: You will normally have a copay or coinsurance for eye surgery. Please look at you evidence of coverage book to determine this.

Answer: This is a personal question.

Many people like having straight Medicare and a part D prescription plan because more doctors accept straight Medicare. However you will owe the part A & B deductibles and normally 20% of the approve with no out of pocket maximum.

I would advise a Medicare Supplement with straight Medicare to pick up some of the out of pocket costs.

Medicare Advantage plans have their place but normally have a network of doctors and hospitals to adhere to and have prior authorizations for care. They also have copays and coinsurance but do have a maximum out of pocket you would spend in a year. Most do offer some coverage for dental, vision and hearing as well.

Answer: I hate that seniors are bombarded with these ads and phone calls. The government is suppose to cracking down on this but I have not seen it. I turned 65 in 2025 and my phone rings constantly with people trying to sell me plans.

Answer: It is unlikely that Medicare will run out of money before you benefit from it.

Medicare part A is predicted to run out of money by 2026 but tax revenues will support probably with lower benefits.

Answer: There are many things I would change about Medicare.

I would have regular Medicare cover dental, vision and hearing aids.

Medicare Advantage plans should have better customer service.

Answer: It does not effect your Medicare coverage or eligibility however it could effect your premiums. Your income and your spouses is counted towards the income related monthly adjustment amount or IRMAA. If your income together are over a certain amount you will pay higher premiums for your Part B of Medicare.

Answer: You have several options and should discuss them with your HR department to see which is best for you.

You can continue your federal plan and not choose Medicare or the can choose Medicare A & B and keep you federal plan and benefits will be coordinated.

Answer: Yes Medicare should cover dental, vision and hearing. We all know dental issues can cause many other health issues and a person with hearing issues can feel isolated and depressed. Which both will cost more in the long run.

Answer: Some hospitals are not taking Medicare Advantage plans. Because of prior authorizations leading to higher administrative costs and reimbursements taking so long.

Answer: As the population ages it will put a strain on Medicare part A. Increased hospital stays and less revenue is an issue.

Answer: There have been several laws passed that are protecting this from happening. Such as the Income Related Monthly Adjustment Amount "IRMAA." Those who have a higher income pay higher premiums for Medicare. These premiums are on a sliding scale, meaning the more you make the more you pay.

Answer: The main reason for this is that Medicare has income limits for couples, that will effect your Medicare premiums. If one passes away you are now under the single income which can effect your premium.

Answer: Yes, Medicare Advantage plans will cover acupuncture like original Medicare and can offer alternative therapies. make sure you review your plans benefits.

Answer: I have seen many caregivers end up sicker than the person they are taking care of. It is very important for the care giver to take care of their own mental health. Medicare will pay for both in patient and out patient mental health.

Answer: Mental health therapy is covered inpatient and outpatient at 80% by Medicare leaving a 20% copay and one time deductible of $257.00 in 2025.

Answer: The Annual Enrollment period is the time to compare plans and to make sure you get the plan that covers your doctors and medications at the best copays.

Answer: That Medicare will cover the full amount of their bill and that all insurance companies are the same.

Answer: Helping people understand how Medicare works and their Insurance options.

Listening to the client and figuring out witch plan will best fit their needs.